Abstract
We report a case of post-streptococcal reactive arthritis (PSReA) and its management in a 39-year-old woman who presented to the emergency outpatient department of our hospital with fever and pharyngitis on Y–17 days in month X. Physical examination revealed pus adherent to the palatine tonsils; therefore, the patient was prescribed oral amoxicillin for a diagnosis of bacterial tonsillitis and was instructed to return home. However, she observed persistent fever and pharyngitis 1 week before day Y of month X and returned to our department with generalized arthritis. Physical examination showed disappearance of the pus adherent to the palatine tonsils, and routine blood test results showed only a slightly elevated white blood cell (WBC) count. Her serum C-reactive protein and anti-streptolysin O (ASO) levels were within normal limits, and the rapid strep test result was negative. In light of the patient’s severe pharyngitis and arthritic symptoms, we measured serum complement levels to screen for possible acute rheumatic fever (ARF), and the patient was prescribed analgesics. However, on day Y+5 of month X, the patient returned with severe sore throat and neck pain. Blood test results showed only a slightly elevated WBC count and a negative erythrocyte sedimentation rate. However, the ASO titer was elevated, and the patient was diagnosed with PSReA based on the development of arthritic symptoms approximately 10 days after a hemolytic streptococcal infection. The symptoms and laboratory test findings observed in PSReA are often indistinguishable from those of ARF; however, the inflammatory response and erythrocyte sedimentation rate elevation are milder than these findings observed in patients with ARF, and cardiac complications are not known to occur. Therefore, PSReA and ARF are categorized as distinct entities. Nonetheless, otolaryngologists should consider PSReA in the differential diagnosis in patients with hemolytic streptococcal tonsillitis/pharyngitis, which is frequently encountered in routine medical practice.
